Format (Practical Examination / OSPE)

MBBS Third Professional Examination

COMMUNITY MEDICINE
Component - I

House Hold Survey: 1. 10 houses.

2. 05 marks (External)
Component – II

Research 1. Mandatory - Group Work (5-6 students)

10 marks (Internal)
2. Individual viva.

Component – III

Journal A. Field Visit journal of 10 visits.

(Internal)
Defined Population/Area.
05 Marks (Internal)

B. Journal of Press Cuttings.

10 cuttings
5 marks
Critical appraisal - different topics.

Total 10 marks (Internal)

Component – IV

OSPE - 40 Marks
1. Graph Interpretation.
2. Calculation.
3. Specimen Identification.

Marks for each station 4

Total Stations 10 non-observed / non-interactive (strictly according
to TOS provided)
Time allocated 40 minutes (4 minutes at each station)

Component – V
Viva Voce
70 Marks External – 35
Internal – 35
 MBBS Third Professional Examination
COMMUNITY MEDICINE

Model Questions of OSPE

Total No. of Stations = 10

Total Marks = 40 (4 Marks for each spot / station)
Time = 40 minutes (4 minutes at one station)

NUTRITION
Q1.
a. Calculate the BMI
b. Give its interpretation.
Key: a
BMI = Weight in Kg
(Height in meter)2
INTERPRETATION BMI
Under weight < 18.5
Normal range 18.5 – 24.9
Over weight ≥ 25
Pre-obese 25 – 29.9
Obese class I 30 – 34.9
Obese class II 35 – 39.9
Obese class III ≥ 40

Key: b
Interpret BMI on the basis of this scale.

Weighting: a. 2 b.1
Reference: Preventive & Social Medicine (K. Park)
 PUBLIC HEALTH & HEALTH SYSTEM / PHC

Q2. POF hospital, Wah is 600 bedded. On an average 500 beds remain occupied
throughout the year; calculate bed occupancy rate of this hospital.

Key: 2
Bed occupancy rate
= 500 x 365 x 100
600 x 365
= 83.33%

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 IMMUNOLOGY

Q.3 Vaccines of EPI are placed in the different compartments of the Refrigerator.
Check their placement and corrective shuffling may be done, if needed.

Key: 3
Among the vaccines, Polio is the most sensitive to heat, requiring storage at minus
20ºC. Measles and polio vaccines must be stored in the freezer compartment. Vaccines which
must be stored in the cold part but never allowed to freeze are typhoid, DPT, Tetanus Toxoid,
DT, BCG and diluents.

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 BIOSTATISTICS

Q4.

Anemia Status Parity status

Parity 1 Parity 4
Anemia 14 16
Non Anemia 46 24

The calculated Chi-square value of the given data is 3.17.

a. Calculate the degree of freedom.
b. By referring to the given χ2 table, interpret the significance of the result.

Key: a
Degree of freedom = (Row -1) x (Column -1)
= (2-1) x (2-1)
=1
Key: b
Since χ2= 3.17
χ2 < 3.84
So P> 0.05
The difference is not significant

Weighting: a.1 b.2

Reference: Preventive & Social Medicine (K. Park)
 DEMOGRAPHY AND POPULATION CONTROL

Q5. Post insertional advice to the patients.

Key: 5
A patient is sitting to be counseled.
1. It is reversible method
2. Immediate Î collapse, syncope(Counsel about symptoms)
3. Late ÎMetrorrhagia, backache, menorrhagia
4. It will not interfere with your marital / sex life
5. You can still become pregnant as it does not give 100% protection
6. It can be lost also.
7. It can perforate the wall of uterus.
8. You can check the IUCD in position by the thread
9. Follow-up
10. Duration
a. Copper T Î 10 years
b. Multiload Î 5 years
Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 REPRODUCTIVE HEALTH

Q6. A woman reports at BHU with edema and blood pressure of 150/95 mm of Hg at
the gestational age of 34 weeks.
a. What is this condition called?
b. What are the risks to the baby and to the mother?

Key: a
The condition is called pre-eclampsia.
Key: b
Patient may develop eclampsia. It is also called Toxemia of pregnancy and it is one of
the major causes of maternal mortality, 13% of deaths are due to toxemia of pregnancy.
Babies are likely to have low birth weight and are prone to mortality.

Weighting: a.1 b.2

Reference: Preventive & Social Medicine (K. Park)
 COMMUNICABLE DISEASES / REPRODUCTIVE HEALTH / IMMUNOLOGY
Q.7 A pregnant woman is bitten by a rabid dog. Outline the steps of
management.

Key: 7
If a woman is bitten by a rabid dog:
¾ It is advisable to give both active and passive immunization as Rabies vaccine is a
killed vaccine and can be given safely during pregnancy.
¾ Wound toilet with proper antiseptic measures should be done.
¾ No suturing should be done before 24 hours.

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 COMMUNICABLE DISEASES / NUTRITION / IMMUNOLOGY

Q.8 Mother is Hepatitis B positive, what advice would you give after delivery
regarding:
a. The baby’s immunization
b. Breast feeding.

Key: a
i. Passive immunization
Hepatitis B immunoglobulin 0.05 to 0.07ml/kg body weight should be given. Two doses
should be given 30 days apart.
ii. Active immunization
1st dose of Hepatitis B virus vaccine (1ml) should be given intramuscularly with in 7 days
of birth. 2nd and 3rd dose should be given after 1 month and 6 months respectively.
Key: b
Mother can breast feed her baby as immunization has being done.

Weighting: a.2 b.1

Reference: Preventive & Social Medicine (K. Park)
 FOOD & NUTRITION
Q.9
a. Measure the mid arm circumstance.
b. Interpret the results.

Key: a
Method
Key: b
The interpretation is based on the following:
¾ Arm circumstance exceeding 13.5cm = Satisfactory nutritional status.
¾ Between 12.5 and 13.5 = Mild to moderate malnutrition.
¾ Below 12.5 = Severe malnutrition.

Weighting: a.1 b.2

Reference: Preventive & Social Medicine (K. Park)
 COMMUNICABLE DISEASES / NUTRITION

Q.10 The mother is tuberculous:

a. What instructions would you give for breast feeding of the baby?

b. What measures should be taken to prevent the baby from acquiring this
infection in the immediate post natal period.

Key: a
Breast feeding recommended.
Key: b
ƒ Baby should be given INH prophylactically
ƒ BCG immunization.
ƒ Mother should observe personal hygiene for protection of tuberculous transmission
to baby:
¾ Use of mask.
¾ Avoid spitting in the room.
¾ etc.

Weighting: a.1 b.2

Reference: Preventive & Social Medicine (K. Park)
 HEALTH EDUCATION

Q.11 Educate a group of people regarding hepatitis B & C.

Key: 11
a. It is called “kala yarqan” in common language.
b. Modes of transmission:
¾ Blood transfusion
¾ Sharing of needles / syringes / blades
¾ Sexual transmission
¾ Vertical transmission
c. Health education pertaining to the modes of transmission:
¾ Not to share razors / blades / syringes
¾ Screenings of blood / blood products before transfusion
¾ Remain confined to your marriage partner only and use of condoms.
¾ Avoid unnecessary surgical / dental procedures
d. Immunization:
¾ Hepatitis B vaccine has been recently included in national EPI campaign. 3
doses of vaccine are given on 6, 10 and 14 weeks after birth, along with DPT
vaccine.
¾ There is no vaccine against Hepatitis C. All the preventive measure are the
same as against hepatitis B. Concept of safe sex is important in control of
both types of hepatitis, which include confinement to marriage partners only
and use of barrier methods (Condoms).

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 ENVIRONMENT

Q.12 Calculate the amount of bleaching powder (33% strength) required to disinfect a
well having diameter of 1.8m and depth of water 30m.

Key: 12
First method.
Volume in liters = 3.14 x d2 x h x 1000
4
= 3.14 x (1.8)2 x 30 x 1000
4
= 3.14 x 3.24 x 30 x 1000
4
= 76302 liters
For 1000 liter required amount of bleaching powder = 2.5 gm
For 76302 liter required amount of bleaching powder = 2.5 x 76302
1000
= 190.755 gms
= 191 gms
Second method.
Volume in liters = D2 x W x 800 (D = diameter in meters
W = depth of water in meter)
2
= (1.8) x 30 x 800
= 3.24 x 30 x 800
= 77760 liters
For 1000 liter required amount of bleaching powder = 2.5 gm
For 77760 liter required amount of bleaching powder = 2.5 x 77760
1000
= 194 gms

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 EPIDEMIOLOGY

Q.13 In a population of 1000, measles immunization coverage is 60%, one child goes
out of station and comes back with measles from whom 20 more children get
measles. Calculate secondary attack rate of measles.

Key: 13
Total no. of children = 1000
No. of immunized = 600
No. of un-immunized =400
Primary case = 1
Secondary attack rate = 20 / 400 – 1 = 20 / 399 x 100 = 5%

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 SCREENING

Q.14 By referring to the following table, calculate:

¾ Sensitivity (1)
¾ Specificity (1)
¾ Positive predictive value (0.5)

DISEASE NO DISEASE
Test + 9 50 59
Test - 1 940 941
10 990 1000

Key: 14
¾ Sensitivity = 9/10 x 100 = 90%
¾ Specificity = 940 / 990 x 100 = 95%
¾ PPV = 9/59 x 100 = 15%

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 DEMOGRAPHY & REPRODUCTIVE HEALTH

Q.15 Statistics of a Maternity Unit include the following:

¾ Total numbers of reported live births at this obstetrical unit = 5000.

¾ No of deaths of children < 1 year of age= 80
¾ No of deaths of children below 6 months of age = 70
¾ No of deaths of children below 28 days of age = 60
Calculate Neonatal Mortality Rate.

Key: 15
60 / 5000 x 1000 = 12 / 1000 live births

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 OCCUPATIONAL HEALTH

Q.16 The person sitting in front of you is a nursing assistant, working in the medical
ward of POF hospital, Wah Cantt. On average he gives 10 to 15 injections to the
patients per day. How will you educate him to prevent himself from the needle
stick injury?

Key: 16
¾ He must keep in mind the risk of having needle stick injury while giving the injections to
the patients.
¾ He must take particular care during the following stages of giving injections:
o During tightening the needle on the syringe
o Pulling out the needle from the ampoule after filling the injection
o Insertion of the needle into the skin or vein
o Pulling out of the needle after giving injection
o During capping of the used needle
¾ In case of needle stick injury he should report to his senior immediately about the
incident.
¾ Active immunization if not vaccinated.
¾ Passive & active immunization if needle stick injury results before active immunization.
(When handling a hepatitis B+ patient)

Weighting: 3
Reference: Preventive & Social Medicine (K. Park)
 Conduct of OSPE
• The Batches for Major viva voce and Practical / OSPE exam will be the same on any particular
day and will be 30 students strong each.
• All OSPE Questions will be sent by the Department of Examinations, UHS in sealed confidential
envelopes to each center clearly marked for each day of Examination and shall be kept secure
in our Regional Safety Lockers at respective centres.
• For any particular day of Examination the same OSPE questions will be sent to each center to
maintain uniformity and standardization.
• The sealed confidential envelope containing the OSPE questions for that particular day will be
collected from the UHS regional safe locker by both the Internal and External Examiners in the
presence of the Principal or his nominee and the Regional Coordinator up to Two hours before
the commencement of Examination.
• Each packet of examination material will contain for that particular day the complete set of
OSPE questions with keys and instructions for the candidates and the examiners.
• Instruction/ questions for the candidates will be included in the examination material and should
be placed on each station.
• The Practical Answer Books for stations will be sent separately to each centre one for each
candidate.
• The candidates are to carry the Practical Answer Books from station to station and are to
register their responses to each question at these desks separately on the same Practical
Answer Sheet in the designated areas.
• Before leaving the Assessment Hall the candidate should deposit the Answer Book either at the
“Marking Desk” or with the organizer as per decision of the convener.
• The answer books will be checked by both the Internal and External (5 Questions by the Internal
and 5 by the External) and awards will be transferred to the Award Lists.
• Both the Award List and the Answer Books will be sent to the Examination Department on the
same day.
• The candidates leaving the OSPE Hall will not mingle with candidates awaiting assessment,
who are to be kept under supervision in a separate holding bay.
• Each batch of the candidates while waiting for the OSPE in the waiting area should be briefed
about the OSPE process and the layout of the OSPE hall as well as the flow of candidates
through the hall. They are not to bring any mobile phones or any other technology that could be
used for communication within the premises of the examination centre.
• Any student found having mobile phone or any other electronic medium should be removed
from the OSPE examination centre and an Unfair Means Case registered against him/ her.
• All candidates will complete a mandatory “Feedback Proforma” and deposit the same
confidentially in the sealed collection boxes provided.
 List of Calculations

1. Mortality ratio.
2. Morbidity ratio.
3. Disability ratio.
4. Fertility ratio.
5. Dependency ratio.
6. Bed Occupancy ratio.
7. Secondary attachment rate.
8. Ration.
9. Doubling Time.
10. Growth Rate.
11. Mean, Median, Mode, Standard Deviation, Range.
12. Measures of Dispersion.
13. Sensitivity / Specificity.
14. Negative Predictive Value.
15. R.R.
16. Att. Risk.
17. Odds Ratio.
18. Incidence / Prevalence.
19. Chi-Square (p Value).
20. BMI.
21. Calculation of Caloric Value.
22. B. demographic equation.
23. Doubling Time of Population.
24. Quality of H2O in well.
25. Chlorine Demand.

List of Models
1. Sand fly.
2. Lifecycle of flea.
3. Lifecycle of House Fly.
4. Lifecycle of Mosquito.
5. Diphtheria open mouth.
6. Measles.
7. Iodine deficiency goiter.
8. Kwashiorkor.
9. Chicken pox.
10. Mumps.
11. Healthfull house.
12. Various desk (plus).
13. Various desk (minus).
14. Various desk (zero).
15. Various desk (Normal).
16. Mite.
17. Tetanus (model).
18. Leprosy.
19. Tick.
20. Septic Tank.
21. Hydatid cyst.
22. Worms.
23. AIDS.
 List of Oils
All oils.
List of Antiseptics and Chemicals

1. Dettol liquid.
2. Dettol soap.
3. Pyodine.
4. Sulpher.
5. Phenyl tablet.
6. Bleaching powder.
7. Formalin.

List of Pulses, Rice and Salts

1. Pulses.
2. Beans.
3. Corns.
4. Wheat.
5. Rice.
6. Iodized Salt.
Miscellaneous

1. Stop watch.
2. Snake.
3. Anti Snake kit.
4. All vaccines.
5. All contraceptives.
6. O.R.S.
7. Cigarette.
8. Syringes.
9. Huka / Shisha.
10. Anti TB drugs.
11. Anti Malarial drugs.
12. Deworming medication.
13. Iron dust.
14. Cotton fibers.
15. Coal.
16. Skimmed milk.
17. Population pyramid.
18. X-Ray (TB).
 MBBS Third Professional Examination
COMMUNITY MEDICINE
TOS for OSPE
TOTAL SPOTS / STATIONS: 10
TOTAL MARKS: 40 (4 MARKS / STATION)
TOTAL DURATION: 40 MINS (4 MINS AT A STATION)
S.# Topics C1 C2 C3 Weighting % of items per Content
(30%) (30%) (40%)
1 Concept of health and disease, Natural history of disease
and levels of prevention, Control, Elimination and 1 Spot = 4 Marks
eradication 1 Spot 10%
1a. General epidemiology and research methodology,
9 9 9
Dynamics of infectious disease transmission.
1a. Epidemiology, control and prevention of
Communicable and non communicable diseases.
Screening
2 Introduction to public health and health system 1 Spot = 4 Marks
9 9 9 1 Spot 10%
Primary heath care, Health system in Pakistan.
3 1 Spot = 4 Marks
Immunology / Vaccination 9 9 9
1 Spot 10%
4 1 Spot = 4 Marks
Biostatistics/HMIS 9 9 9 1 Spot 10%
5 1 Spot 1 Spot = 4 Marks
Food & Nutrition 9 9 9
10%
6 Environment (Air, water , radiation, climate, noise, 1 Spot 1 Spot = 4 Marks
9 9 9
housing, waste disposal) 10%
7 1 Spot 1 Spot = 4 Marks
MCH / Reproductive health 9 9 9
10%
8 Health education / Dental health / School health / Mental 1 Spot 1 Spot = 4 Marks
9 9 9
health / Behavioral sciences / Counseling 10%
9 Accidents /Disasters / Occupational health / Parasitology 1 Spot 1 Spot = 4 Marks
9 9 9
/ Entomology / Snake bite 10%
10 1 Spot 1 Spot = 4 Marks
Demography and population control 9 9 9
10%
 University of Health Sciences, Lahore
MBBS Third Professional
Annual / Supplementary Examination, 200____
OSPE Award List for Community Medicine

College: _______________ Centre: _________________

Roll Non Observed Station (Max Marks 40) House hold

Major Viva Grand Total
survey
No. 1 2 3 4 5 6 7 8 9 10 Total (Max Marks 35) Figure Words
(Max Marks 5)

Examiners: External _______________________

 University of Health Sciences, Lahore
Third Professional MBBS
Annual / Supplementary Examination, 200____
OSPE Award List for Community Medicine

College: _______________ Centre: _________________

Roll Non Observed Station (Max Marks 40) Research Journal Major Viva Grand Total
(Max (Max Marks (Max
No. 1 2 3 4 5 6 7 8 9 10 Total Figure Words
Marks 10) 10) Marks 35)

Examiners: Internal _______________________